Glucocorticoid is produced from the adrenal gland. In addition, glucocorticoid is converted into an active form from an inactive form at tissue level and acts via its receptor thereof.
11β-hydroxysteroid dehydrogenase (11β-HSD) is an enzyme that catalyzes this conversion, and it is known that there are two subtypes of the enzyme. 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) is an enzyme that converts the inactive form into the active form and is highly expressed in the liver, and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) is an enzyme that converts the active form into the inactive form and is highly expressed in the kidneys.
11β-HSD1 is also known to be highly expressed in the brain, but the 11β-HSD2 is practically not expressed in the brain (Thekkepat C. Sandeep et al., Proceedings of the National Academy of Science, 2004, Vol. 101, p. 6734-6739).
As the relationship between glucocorticoid and patients with dementia, the increase in the level of active glucocorticoid (cortisol) in the saliva or blood in patients with Alzheimer's disease (Giubilei F. et al., Journal of neuroscience research, 2001, Vol. 66, p. 262-265, Zeynel A Erkut et al., Neuropsychopharmacology, 2004, Vol. 29, p. 152-157), correlation between HPA axis disorder (John G Csernansky et al., The American journal of Psychiatry, 2006, Vol. 163, p. 2164-2169) as well as cortisol level and the value of bran atrophy index, and the like have been confirmed (Giubilei F. et al., Journal of neuroscience research, 2001, Vol. 66, p. 262-265). In addition, it has been confirmed that the administration of a cortisol or glucocorticoid preparation to a healthy individual or a patient with Alzheimer's disease induces language disorder or memory disorder (A. H. Young et al., Psychopharmacology, 1999, Vol. 145, p. 260-266, P. S. Aisen et al., Neurology, 2000, Vol. 54, p. 588-593). Moreover, as the relationship between 11β-HSD1 and cognition, they reported an action of improving verbal memory by the administration of non-selective 11β-HSD inhibitor to a patient with type II diabetes mellitus (Thekkepat C. Sandeep et al., Proceeding of National Academy of Science, 2004, Vol. 101, p. 6734-6739), as well as an action of ameliorating cognitive disorder in an aged 11β-HSD1 knockout mouse (Joyce L., W. Yau et al., Proceeding of the National Academy of Science, 2001, Vol. 98, p. 4716-4721), and the like.
In this respect, the 11β-HSD1 inhibitor is expected to suppress the action of glucocorticoid in the brain by inhibiting the conversion of glucocorticoid to the active type, and accordingly remedy cognitive disorder induced by glucocorticoid.
In addition to dementia, the 11β-HSD1 inhibitor is also expected to ameliorate central disorders such as schizophrenia (X. Y. Zhang et al., Neuropsychopharmacology, 2005, Vol. 30, p. 1532-1538), depression (Bernard J. Carroll et al., Archives of General Psychiatry, 1981, Vol. 38, p. 15-22), anxiety (Veen G. et al., Metabolism, 2009, Vol. 58, p. 821-827), Post-Traumatic Stress Disorder (PTSD) (Charney D. S. et al., Archives of General Psychiatry, 1993, Vol. 50, p. 295-305), Attention Deficit/Hyperactivity Disorder (AD/HD) (Hong H. J. et al., Yonsei Medical Journal, 2003, Vol. 44, p. 608-614), panic disorder (Angelika E. et al., Neuropsychopharmacology, 2006, Vol. 31, p. 2515-2522), sleep disorder (Andersen M. L. et al., Journal of sleep research, 2005, Vol. 14, p. 83-90), which are closely related to stress and show HPA axis disorder or the increase in plasma cortisol level.
In addition, as the relationship between 11β-HSD1 and metabolic diseases, increased activity of 11β-HSD1 in the adipose tissue of an obese individual is known (Rask E. et al., The Journal of Clinical Endocrinology & Metabolism, 2001, Vol. 86, p. 1418-1421), and it is reported that the activity of 11β-HSD1 is closely correlated with BMI as the index of obesity, HOMA-IR as the index of insulin resistance, and the fasting blood glucose level (Lindsay R. S. et al., The Journal of Clinical Endocrinology & Metabolism, 2003, Vol. 88, p. 2738-2744). It is also reported that a transgenic mouse over-expressing 11β-HSD1 in an adipose tissue-selective manner shows increase in the level of glucocorticoid in the adipose tissue and insulin resistance, visceral fat obesity, hyperlipidemia, and hypertension (Masuzaki H. et al., Science, 2001, Vol. 294, p. 2166-2170, Masuzaki H. et al., The Journal of Clinical Investigation, 2003, Vol. 112, p. 83-90), and that a 11β-HSD1 knockout mouse shows improvement in glucose tolerance, decrease in blood triglyceride levels, and increase in HDL-cholesterol levels (Morton N. M. et al., The Journal of Biological Chemistry, 2001, Vol. 276, p. 41293-41300).
In this respect, a selective inhibitor of 11β-HSD1 is expected to suppress the action of glucocorticoid in a tissue by inhibiting the conversion of glucocorticoid to the active type, and consequently remedy metabolic abnormality such as hyperglycemia, insulin resistance, obesity, hyperlipidemia, and hypertension induced by glucocorticoid.
It is also reported that a non-selective 11β-HSD inhibitor, carbenoxolone, ameliorates deficient secretion of insulin caused by the addition of inactive glucocorticoid in rat pancreatic β-cells (Davani B. et al., The Journal of Biological Chemistry, 2000, Vol. 275, p. 34841-34844), so the 11β-HSD1 inhibitor has a possibility of ameliorating not only insulin resistance but also hyperglycemia by promoting insulin secretion.
In addition, it is reported that a triazole compound having the 11β-HSD1 inhibitory action is effective in a spinal nerve ligation model as an animal model of neuropathic pain and an animal model of fibromyalgia caused by repeated reserpine administration (Patent Document 1), so the 11β-HSD1 inhibitor is expected to be effective for treating pain, particularly neuropathic pain and fibromyalgia.
Examples of other 11β-HSD1-related diseases include osteoporosis (Cooper M. S. et al., Bone, 2000, Vol. 27, p. 375-381) and glaucoma (Rauz S. et al., Investigative Opthalmology & Visual Science, 2001, Vol. 42, p. 2037-2042), and the 110-HSD1 inhibitor is expected to be effective for ameliorating these diseases.
Patent Document 2 discloses that a compound represented by the following the formula (A) has the 11β-HSD1 inhibitory action and is useful for treating diseases such as diabetic diseases and metabolic syndrome. However, in the compound, the moiety corresponding to amide of the present application is cyclic amide.
(see the corresponding gazette for symbols in the formula)
Patent Document 3 discloses that a compound represented by the following formula (B) has the action of regulating hydroxysteroid dehydrogenases such as 11β-HSD1 and is useful for treating a large number of diseases including diabetes, metabolic syndrome, and dementia. However, this compound does not include a ring corresponding to the ringA of the present application.
(see the corresponding gazette for symbols in the formula)
Patent Document 4 discloses that a compound represented by the following the formula (C) has an inhibitory action against 11β-HSD1, 11β-HSD2, 17β-HSD3, and the like and is useful for treating a large number of diseases including diabetes, metabolic syndrome, and dementia. However, this compound does not include a ring corresponding to the ring A of the present application.
(see the corresponding gazette for symbols in the formula)
Patent Document 5 discloses that a compound represented by the following formula (D) has the action of regulating a TRPV 1 receptor and is useful for treating pain. However, this document does not disclose the 11β-HSD1 inhibitory action and the usefulness of the compound with respect to dementia.
(see the corresponding gazette for symbols in the formula)
Patent Document 6 discloses that a compound represented by the following formula (E) has the action of regulating a histamine H3 receptor and is useful for treating a large number of diseases including obesity, diabetes, and Alzheimer's disease.
(see the corresponding gazette for symbols in the formula)
Patent Document 7 discloses that a compound represented by the following formula (F) has the action of regulating stearoyl-CoA desaturase and is useful for treating hyperlipidemia, circulatory diseases, diabetes, obesity, metabolic syndrome and the like. However, the document does not make disclosures about the 11β-HSD1 inhibitory action and usefulness of the compound with respect to dementia.
(see corresponding gazette for symbols in the formula)
Patent Document 8 discloses that a compound represented by the following formula (G) has the action of regulating a C5A receptor and is useful for treating various inflammatory diseases and immunological diseases. However, the document does not disclose the 11β-HSD1 inhibitory action.
(see the corresponding gazette for symbols in the formula)
Patent Document 9 discloses that a compound represented by the following formula (H) has an antibacterial activity and is useful for treating infection. However, the document does not disclose the 11β-HSD1 inhibitory action and the usefulness of the compound with respect to dementia.
(see the corresponding gazette for symbols in the formula)